The pathogenesis of urolithiasis is not yet clear， and there are obvious limitations in the prevention and treatment of urolithiasis by either Chinese or western medicine. The microscopic pathological changes of the kidney from anatomical perspective have a certain internal connection with viewpoint of “kidney storing insufficiency， and kidney deficiency as the root” in the traditional Chinese medicine （TCM） zang-fu （脏腑） theory. Accordingly， the prevention and treatment of urolithiasis by integrated traditional Chinese and western medicine based on “shen-kidney” theory has been proposed. It is believed that the prevention and treatment of urolithiasis can be divided into two stages， that is expelling stones and preventing stones. In terms of preventing stones from kideny， it is recommended to focus on the early pathological changes of the kidney； for preventing stones from shen， it is advised to prevent and treat urolithiasis from kidney deficiency. The treatment should be time-based and stage by stage. Adhering to the principle of “prevention before disease occurs， prevention is more important than treatment” aims to advance the intervention targets for the prevention and treatment of urolithiasis. Emphasizing on the simultaneous treatment of kidney disease and urolithiasis， it is critical to put focus on the development of calcium-containing crystalline nephropathy in the early stage of stone formation， as well as the fundamental pathogenesis of kidney deficiency in TCM. Shen-kidney theory aims to further promote the integration of traditional Chinese and western medicine in the prevention and treatment of urolithiasis， which may provide certain reference for solving the current dilemma of urolithiasis prevention and treatment.

OBJECTIVE: To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures. METHODS: A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups ( P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up. RESULTS: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups ( P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B ( P<0.05). There was no significant difference in the other items of Bostman scores between the two groups ( P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B ( P<0.05). CONCLUSION Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.
Humans ; Blood Loss, Surgical ; Bone Wires ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Knee Injuries ; Patella/surgery* ; Retrospective Studies ; Suture Anchors ; Treatment Outcome ; Male ; Female

Objective:To explore the predictive value of single high-sensitivity cardiac troponin I (hs-cTnI) concentration of 30-day cardiovascular adverse events in patients with suspected acute coronary syndrome (ACS).Methods:This is a multicenter, prospective and observational clinical study. Patients with suspected ACS who were admitted into the emergency department of Fuwai Hospital, the First Affiliated Hospital of Sun Yat-sen University and Nanjing First Hospital from January 2017 to September 2020 were enrolled. hs-cTnI result at the time of visit was obtained from patients with suspected ACS. Patients were followed up for 30 days and patients were divided into no events group and events group according to the presence or absence of 30-day cardiovascular adverse events (acute myocardial infarction (including index), unplanned revascularization and cardiovascular death). The predictive value of single Hs-cTnI at different concentration thresholds on the adverse event was evaluated in terms of sensitivity, negative predictive value (NPV) and 95% confidence interval ( CI). The best threshold was defined as: missed diagnosis rate <2% and NPV >99%. Patients were sub-grouped according to the confounders of hs-cTnI (sex, age, chest pain duration, estimated glomerular filtration rate), and Chi-square test was used to compare sensitivity and NPV among various subgroups. Results:A total of 1 461 patients were included. Among them, 387 patients (26.5%) had 30-day adverse cardiovascular events and 1 074 patients (73.5%) had no adverse cardiovascular events. Mean age was (62±12) years old and 905 were males (61.9%). When the concentration of hs-cTnI was less than 2 ng/L (limit of detection), the missed diagnosis rate of 30-day cardiovascular adverse events was 0.8% (3/387), the sensitivity was 99.2% (95% CI 97.6%-99.8%), and NPV was 98.7% (95% CI 96.0%-99.7%). When hs-cTnI concentration was less than 6 ng/L, the missed diagnosis rate was 1.8%, the sensitivity was 98.2% (95% CI 96.1%-99.2%), and NPV was 99.0% (95% CI 97.9%-99.6%). Subgroup analysis showed that the sensitivity and NPV of single hs-cTnI concentration <6 ng/L for 30-day cardiovascular adverse events were lower in patients with chest pain less than 3 h than those with chest pain time>3 hours ( P<0.05). Conclusions:Single hs-cTnI concentration less than 6 ng/L can predict the risk of 30-day cardiovascular adverse events in suspected ACS patients, but continuous monitoring is recommended for patients with chest pain onset≤3 hours.

Objective:To explore the clinical efficacy of kidney transplantation(KT)from senile living-related donors aged over 70 years.Methods:Between 2017 and 2019, perioperative and follow-up data from 18 pairs of donors and recipients were retrospectively reviewed.Results:Operations of all 18 pairs of recipients and donors were conducted successfully without serious perioperative complications.No delayed graft function occurred.There was 1 episode(5.6%)of acute rejection.The mean level of serum creatinine(SCr)at Day 3 post-KT and at discharge was(155.7±63.5)and(97.6±28.7)μmol/L.The median follow-up period was 37.5 months.All 18 donors survived with normal renal function.And no proteinuria or kidney donation related hospitalization events occurred.SCr was(84.4±15.0)μmol/L at the last follow-up and there was no statistical significance as compared with SCr level at discharge( P=0.610). No recipient mortality or graft loss occurred.Levels of SCr were(92.1±18.3), (95.5±21.9)and(100.1±21.2)μmol/L at Month 12/24 and the last follow-up.No statistical difference existed in posttransplant SCr level at these follow-up timepoints( P=0.507). Posttransplant proteinuria occurred in 3 recipients(16.7%). In 8 donors, donated kidney glomerular filtration rate(GFR)was lower than 40 ml/(min·1.73m 2). No statistical difference existed in posttransplant SCr level between this group and higher GFR group( P>0.05). Conclusions:After thorough preoperative assessments, satisfactory short-term outcomes may be achieved for KT from living-related donors aged over 70 years.The long-term outcome should be further explored.

Objective:To investigate the clinical characteristics of vasa previa (VP) with low-lying placenta (LP).Methods:A retrospective case-control study was conducted on pregnant women with VP who delivered at Guangzhou Women and Children's Medical Center from January 2015 to August 2021. According to the status of LP, these cases were classified into VP with LP (VP+LP) and VP without LP (VP-LP) group. The cases diagnosed with placenta previa (PP, n=128) during the same period were collected as control. Maternal-fetal clinical characteristics and outcomes were compared among the three groups using t-test, Mann-Whitney U test, and Chi-square test (or Fisher's exact test). Results:During the study period, 116 VP cases were diagnosed, accounting for 0.085% (116/136 450) of all deliveries. Apart from one case of intrauterine death caused by non-VP reasons in the third trimester, there were 64 in the VP+LP group and 51 in the VP-LP group. VP+LP cases accounted for about 2.9% (64/2 219) of all the cases with PP or LP. The proportions of multiparae and women with a history of cesarean section were significantly higher in the VP+LP group than in the VP-LP group [62.5% (40/64) vs 39.2% (20/51), χ 2= 6.17, P=0.013; 31.3% (20/64) vs 13.7% (7/51), χ 2= 4.85, P=0.028]. Besides, a rare type of VP (type Ⅲ) was only found in the VP+LP group (9.4%, 6/64). The median gestational age at first diagnosis by prenatal ultrasound was significantly larger in the VP+LP group than in the VP-LP group [28.3 (23.6-31.7) vs 23.9 (23.3-25.9) weeks, Z=2.61, P=0.007]. There was no significant difference in the incidence of antepartum hemorrhage between the two groups. In contrast, the amount of postpartum hemorrhage was significantly increased in the VP+LP group [550 (436-732) vs 420 (300-540) ml, Z=3.37, P=0.001]. Compared with the VP-LP group, the VP+LP group showed a lower incidence of lower neonatal Apgar score (<7 at 5 min) and hypoxic-ischemic encephalopathy [0.0%(0/64) vs 6.9%(4/58), 0.0%(0/64) vs 8.6% (5/58), Fisher's exact test, both P<0.05]. No neonatal death was reported in the VP+LP and VP-LP groups. No significant difference in the incidence of antepartum hemorrhage was found between the VP+LP group and the PP group. Still, the median time at delivery was earlier [36.0 (34.3-36.9) vs 37.0 (35.7-37.3) weeks, Z=3.79, P<0.001], and the incidence of abnormal fetal heart rate was higher [10.9% (7/64) vs 3.1% (4/128), Fisher's exact test , P=0.044] in the VP+LP group. Furthermore, the neonatal NICU admission rate and the incidence of respiratory distress syndrome were significantly higher in the VP+LP group than in the PP group [36.4% (24/66) vs 12.1% (16/132), χ 2= 16.04, P<0.001; 25.8% (17/66) vs 12.1% (16/132), χ 2= 5.89, P=0.015]. Conclusions:For VP+LP cases, there might be an additional type (type Ⅲ VP). Patients with VP+LP would have more blood loss within 24 h after delivery and a higher risk of adverse neonatal outcomes. Intensive attention should be paid to those diagnosed with LP during the third trimester to identify any VP.

OBJECTIVE: To explore the effect of the composition ratio on substitution of sulfate group in sulfated exopolysaccharide (EPS) from and how sulfate modification affects the anti-tumor activity of EPS. METHODS: We used a chlorosulfonic acid-pyridine method to modify EPS and analyzed the effect of esterification ratio on the degree of sulfate substitution using barium chloride turbidimetry. The sulfate groups binding with EPS were analyzed with infrared spectrum analysis. CCK-8 assay was used to evaluate the inhibitory effect of EPS sulfate (SEPS) on the proliferation of human colon cancer HCT 116 cells, and annexin V-FITC/PI double staining was used to assess the pro-apoptotic effect of SEPS in the cells. RESULTS: The esterifying agent and EPS at the composition ratios of 1:1 and 2:1 resulted in sulfate substitution of 0.98% (SEPS-1) and 1.18% (SEPS-2), respectively, and the substitution was improved by increasing the ratio of the esterifying agent ( < 0.05). Infrared spectrum analysis showed that the S=O stretching vibration absorption peak of -OSO appeared near 1249 cm, indicating that the sulfate group combined with EPS to form sulfate. CCK-8 assay showed that SEPS-1 produced stronger inhibitory effects on the proliferation of HCT 116 cells than EPS within the concentration range of 0.02-0.10 mg/L ( < 0.05). At the concentrations of 0.04-0.08 mg/L, SEPS-2 showed a lower anti-tumor activity than SEPS-1 ( < 0.05). SEPS-1 also showed stronger pro-apoptotic effect than EPS, and as its concentration increased, SEPS-1 dose-dependently increased the ratio of early apoptotic cells and necrotic cells; the cells treated with 0.06, 0.08 and 0.10 mg/mL SEPS-1 showed early apoptotic rates of 6.38%, 11.8% and 12.5%, and late apoptotic and necrotic rates of 5.26%, 8.04% and 6.80%, respectively. CONCLUSIONS The composition ratio of the esterifying agent has a direct impact on the degree of substitution of EPS, which can be improved by increasing the ratio of the esterifying agent. Sulfate modification of EPS can enhance its antitumor activity, which, however, is not directly related with the degree of substitution.

OBJECTIVE： To study therapeutic effects of Spider toxin oral ulcer powder on recurrent aphthous ulcer （RAU） model rats and its mechanism. METHODS： In vitro antimicrobial activity of the powder was determined by disk diffusion method. 50 healthy SD rats were randomly divided into normal group， model group， positive group （Guilin watermelon frost， 100 mg/kg） and oral ulcer powder high-dose and low-dose groups （70， 35 mg/kg）， with 10 rats in each group. Except for normal group， RAU model was established in the right oral submucosa of rats in other groups by acetic acid method. After modeling， administration groups were smeared with corresponding drugs on ulcers for 3 days. Normal group and model group were not treated. The ulcer surface of rats was observed and the ulcer area was measured on the 1st and 3rd days after administration. The morphological changes of ulcer tissues were observed. The serum levels of SOD， MDA， GSH， TNF-α， IL-1， IL-6 and IFN-γ were detected. The protein expressions of MMP-9， NF-κB， Caspase-3 and PARP in ulcer tissues of rats were detected by immunohistochemistry. RESULTS： The oral ulcer powder showed obvious in vitro bacteriostasis effect. Compared with blank group， oral ulcer and histopathological changes were obvious in model group； serum levels of TNF-α， IL-1， IL-6 and MDA were increased significantly， while the levels of IFN-γ， SOD and GSH were decreased significantly （P＜0.01）； the expression of MMP-9， NF-κB， Caspase-3 and PARP in ulcer tissue were increased significantly （P＜0.05 or P＜0.01）. Compared with model group， the ulcer area of rats in each dosage group was significantly reduced （P＜0.05 or P＜0.01） or nearly healed， the pathological changes of  tissue were significantly alleviated； serum levels of MDA， TNF-α， IL-1 and IL-6 were decreased significantly， while the levels of SOD， GSH and IFN-γ were increased significantly （P＜0.05 or P＜0.01）； the expression of MMP-9， NF-κB， Caspase-3 and PARP in ulcer tissue were decreased significantly （P＜0.01）. CONCLUSIONS： Spider toxin oral ulcer powder shows strong bacteriostasis， detumescence and repair effects， and has obvious therapeutic effect on RAU model rats. Its mechanism may be related to reducing the level of inflammatory factors， mediating the expression of apoptotic factors and regulating immune imbalance.

BACKGROUND: Lung cancer is the leading cause of cancer-related death in China. The results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. The aim of tihs study is to establish the China National lung cancer screening guidelines for clinical practice. METHODS: The China lung cancer early detection and treatment expert group (CLCEDTEG) established the China National Lung Cancer Screening Guideline with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 2 medical oncologists, 2 pulmonologists, 2 pathologist, and 2 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with at risk for lung cancer. The expert group reviewed the literature, including screening trials in the United States and Europe and China, and discussed local best clinical practices in the China. A consensus-based guidelines, China National Lung Cancer Screening Guideline (CNLCSG), was recommended by CLCEDTEG appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China. RESULTS: Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation. CONCLUSIONS A lung cancer screening guideline is recommended for the high-risk population in China. Additional research , including LDCT combined with biomarkers, is needed to optimize the approach to low-dose CT screening in the future.
Aged ; China ; epidemiology ; Early Detection of Cancer ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; epidemiology ; Male ; Mass Screening ; Middle Aged ; Patient Selection ; Practice Guidelines as Topic ; Radiation Dosage ; Risk ; Rural Population ; statistics & numerical data ; Tomography, Spiral Computed

Objective To investigate the impact of hepatectomy combined with splenectomy on hepatitis B virus (HBV) reactivation in patients with hepatocellular carcinoma (HCC) ≤5 cm and with hypersplenism.Methods This is a retrospective case-control study on 167 patients with HCC ≤5 cm and with hypersplenism who underwent hepatectomy combined with splenectomy at the Shengli Oilfield Central Hospital between May 2008 and June 2015.64 patients underwent hepatectomy combined with splenectomy,and 103 patients hepatectomy alone.The patients were assigned to the hepatectomy combined with splenectomy group (the combined group,n =61) or the hepatectomy alone group (the control group,n =61) using propensity score matching (PSM).Logistic regression was used to evaluate the relative clinical factors associated with HBV reactivation.The stratified Chi-squared test was utilized to determine the impact of the surgical procedure and preoperative anti-viral therapy on postoperative hepatitis B virus reactivation of these patients.Results The serum PLT level,Child-Pugh grading,tumor diameter and surgical procedures were shown to be independent risk factors associated with postoperative HBV reactivation (P ＜ 0.05).To study the impact of preoperative anti-viral therapy on postoperative HBV reactivation:-the incidence of HBV reactivation was higher in the control group than in the combined group (19.7％ vs.6.6％,P ＜ 0.05).In the combined group,there was no significant difference between patients who received anti-viral therapy and those who were treatment-naive (5.3％ vs.7.1％,P ＞0.05).In the control group,a higher incidence of HBV reactivation was found in patients with treatment-na(i)ve than in patients who received anti-viral therapy (26.1 ％ vs.0,P ＜ 0.05).For the patients who received anti-viral therapy,there was no significant difference between the combined group and the control group (5.3％ vs.0,P ＞ 0.05).In patients with treatment-na(i)ve,a higher incidence of HBV reactivation was observed in the control group than the combined group (26.1％ vs.7.1％,P ＜ 0.05).Conclusions In patients who were not treated with antiviral therapy,hepatectomy combined with splenectomy decreased the incidence of postoperative HBV reactivation in patient with HCC ≤5 cm and with hypersplenism.For the patients who received preoperative anti-viral therapy,the incidence of postoperative HBV reactivation was not decreased with hepatectomy combined with splenectomy.

Objective To investigate the risk factors of standard selectivity biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) for patints with choledocholithiasis,and the effect and safety of assistant cannulation methods.Methods The clinical data were retrospectively analyzed in 372 patients,who received ERCP for choledocholithiasis in the Yijishan Hospital of Wannan Medical College from January 2014 to December 2014.The risk factors of standard biliary cannulation were assessed by univariate and multivariate logistic regression analysis.The success rate of assistant biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) of standard biliary cannulation were compared with doubleguide wire technique (DGT) and precut sphincterotomy (PS),which were used when standard biliary cannulation failed.Results The univariate analysis showed that floppy and long duodenal papilla (P=0.000),angulated common bile duct(P=0.013) were related to failure of standard biliary cannulation.Multivariate analysis showed that floppy and long papilla (P=0.000,OR=0.131,95％CI:0.056-0.307),angulated common bile duct (P =0.003,OR =0.378,95 ％ CI:0.197-0.726) were independent risk factors for standard biliary cannulation.The success rate of standard biliary cannulation was 83.3％ (310/372),62 cases undergone DGT or PS after standard biliary cannulation failure,and the total success rate of cannulation was 99.7％ (371/372).There were 29 cases suffered from PEP in 371 successful cases of biliary cannulation,including 18 cases (5.8％,18/310) of standard biliary cannulation,8 cases (16.3％,8/49) of DGT,and 3 cases (25.0％,3/12) of PS.The incidence of PEP by DGT (x2 =5.532,P =0.019) and PS (x2 =6.994,P=0.008) was significantly higher than that of standard biliary cannulation,but there was no statistical difference on the incidence of PEP between DGT and PS (x2 =0.079,P =0.778).Conclusion Floppy and long duodenal papilla and angulated common bile duct could easily induce the failure of standard biliary cannulation in ERCP for patients with choledocholithiasis.DGT and PS are effective assistant cannulation methods when the standard cannulation fails.